Referral request

Use this service to request a referral from a doctor.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on Main Site Abbey Lane 01142740017 or Branch Site Baslow Road 01142365090.